POS0550 LONG TERM EFFICACY OF A 2-YEAR MRI TREAT-TO-TARGET STRATEGY ON DISEASE ACTIVITY, MRI INFLAMMATION AND PHYSICAL FUNCTION IN RHEUMATOID ARTHRITIS PATIENTS IN CLINICAL REMISSION: FIVE YEAR FOLLOW-UP OF THE IMAGINE RA-COHORT
Authors: S. Møller-Bisgaard, K. Hørslev-Petersen, D. Glinatsi, B. Ejbjerg, M. L. Hetland, J. Møllenbach Møller, R. Christensen, S. M. Nielsen, M. Boesen, K. Stengaard-Pedersen, O. Madsen, B. Jensen, J. A. Villadsen, E. M. Hauge, O. Hendricks, H. M. Lindegaard, N. Steen Krogh, A. G. Jurik, H. Thomsen, M. Østergaard
Journal: Annals of the Rheumatic Diseases (2022)

Background Targeting MRI remission in rheumatoid arthritis (RA) patients in clinical remission may improve long term clinical, functional and MRI outcomes. Objectives To investigate whether a 2-year treat-to-target (T2T) strategy, based on structured MRI assessments targeting absence of osteitis combined with clinical remission, compared with a conventional clinical T2T strategy targeting clinical remission only, improves disease activity, physical function and suppresses MRI-inflammation over 5 years in RA patients. Methods The IMAGINE-more trial was designed as an extension protocol to the 2-year IMAGINE-RA randomised controlled trial (RCT). IMAGINE-RA included 200 RA patients, in clinical remission (DAS28-CRP&lt;3.2 and no swollen joints), who received conventional synthetic disease-modifying antirheumatic drugs (csDMARD) and investigated whether an MRI T2T strategy targeting absence of osteitis in combination with clinical remission (DAS28-CRP≤3.2 and no swollen joints) could increase remission rates and prevent erosive progression compared with a conventional T2T strategy targeting clinical remission only. If target was not met, treatment was escalated according to a predefined treatment algorithm starting with increment in csDMARDs and then adding biologics. At the end of the study, participants were invited to participate in the IMAGINE-more follow-up study. Patients were managed in routine outpatient clinic and had three IMAGINE-more visits including clinical examination (year 3, 4 and 5) and contrast-enhanced MRI of the dominant wrist and 2 nd -5 th metacarpophalangeal joints (year 3 and 5). The primary clinical endpoint was the proportion of patients achieving DAS28-CRP remission (DAS28-CRP&lt;2.6) at year 5. Predefined key secondary outcomes were disease activity (DAS28-CRP), and changes in MRI osteitis (OMERACT RA MRI scoring system (RAMRIS)) and functional level (Health Assessment Questionnaire (HAQ)) from baseline to 5-years follow up. Endpoints were analysed by logistic regression models and repeated measures mixed effects models adjusted for propensity scores corresponding to (remaining in) group allocation. Results Fifty-nine patients in the MRI T2T arm and 72 patients in conventional T2T arm consented to participate. Of these, 47 patients (80%) in the MRI T2T group and 54 patients (75%) in the conventional T2T group reached the primary clinical endpoint (p=0.161) (Table 1 and Figure 1). No statistically significant differences between treatment strategies in key secondary outcomes were seen. Table 1. Primary and key secondary outcomes at 5 years MRI T2T Conventional T2T Difference between groups P value N=59 N=72 Primary endpoint DAS28-CRP remission (DAS28-CRP&lt;2.6), No. (%) 47 (80%) 54 (75%) 2.00 (0.76 to 5.28) 0.161 Key secondary endpoints DAS28-CRP 1.79 (0.08) 1.94 (0.08) -0.15 (-0.38 to 0.07) 0.176 Change from baseline in MRI osteitis (RAMRIS) -0.17 (0.58) 0.18 (0.54) -0.35 (-1.96 to 1.25) 0.663 Change from baseline in HAQ -0.02 (0.03) 0.05 (0.03) -0.07 (-0.15 to 0.01) 0.080 Group estimates are presented as No. (%) for dichotomous data and least squares means (SE) for continuous data. For the primary endpoint, adjusted odds ratio and 95%CI between groups were calculated from a logistic regression model including a fixed factor for treatment arm, and an adjustment for propensity score as a covariate. For endpoints with continuous data, least squares mean differences between groups were calculated based on repeated-measures mixed linear models adjusted for baseline values and propensity scores. Conclusion A 2-year MRI T2T strategy targeting absence of MRI osteitis combined with clinical remission as compared to a conventional clinical T2T strategy in RA patients had no effect on the long-term probability of achieving DAS28-CRP remission. These findnings do not support the use of an MRI-guided strategy for treating patients with RA. References [1]Møller-Bisgaard S et al : JAMA 2019, 321(5):461-472. Disclosure of Interests Signe Møller-Bisgaard Grant/research support from: AbbVie, Kim Hørslev-Petersen: None declared, Daniel Glinatsi: None declared, Bo Ejbjerg: None declared, Merete L. Hetland: None declared, Jakob Møllenbach Møller: None declared, Robin Christensen: None declared, Sabrina Mai Nielsen: None declared, Mikael Boesen: None declared, Kristian Stengaard-Pedersen: None declared, Ole Madsen: None declared, Bente Jensen: None declared, Jan Alexander Villadsen: None declared, Ellen Margrethe Hauge: None declared, Oliver Hendricks: None declared, Hanne Merete Lindegaard: None declared, Niels Steen Krogh: None declared, Anne Grethe Jurik: None declared, Henrik Thomsen: None declared, Mikkel Østergaard Speakers bureau: Abbvie, BMS, Celgene, Eli-Lilly, Galapagos, Gilead, Janssen, Merck, Novartis, Orion, Pfizer, Roche and UCB, Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Grant/research support from: Abbvie, Amgen, BMS, Merck, Celgene and Novartis.